Sever?s Disease is one of the most common overuse injuries affecting children during their secondary growth spurts and is described as a self-limiting condition resolving naturally with skeletal
maturity 1. It is suggested to be caused by progressive microtrauma to the bone-cartilage interface in the calcaneal apophysis partly due to large traction forces in the Achilles tendon. The current
standard treatment consists mainly of rest, and waiting for skeletal maturity.
Sever disease is more common in children who do regular sports or exercise that puts pressure on the heels. Activities such as running and jumping can put stress on the tight muscles and
The most obvious sign of Sever's disease is pain or tenderness in one or both heels, usually at the back. The pain also might extend to the sides and bottom of the heel, ending near the arch of the
foot. A child also may have these related problems, swelling and redness in the heel, difficulty walking, discomfort or stiffness in the feet upon awaking, discomfort when the heel is squeezed on
both sides, an unusual walk, such as walking with a limp or on tiptoes to avoid putting pressure on the heel. Symptoms are usually worse during or after activity and get better with rest.
Sever?s disease can be diagnosed based on your history and symptoms. Clinically, your physiotherapist will perform a "squeeze test" and some other tests to confirm the diagnosis. Some children suffer
Sever?s disease even though they do less exercise than other. This indicates that it is not just training volume that is at play. Foot and leg biomechanics are a predisposing factor. The main factors
thought to predispose a child to Sever?s disease include a decrease in ankle dorsiflexion, abnormal hind foot motion eg overpronation or supination, tight calf muscles, excessive weight-bearing
activities eg running.
Non Surgical Treatment
Rest is best to allow healing .Only do as much exercise as able without causing pain. Many children can continue to play sports but if pain is severe then stopping the activity may be the only way to
allow the pain to settle. The child might be able to do things that do not put pressure on the heel, such as swimming and cycling. Ice and cold therapy may be useful to reduce pain and swelling,
particularly following activity or sport. The area should be iced until it feels cold not ?frozen?. Never apply ice directly onto the skin, as this may cause tissue damage. Medication. The following
will help treat your child?s pain. Paracetamol (see bottle for instructions) Ibuprofen (see bottle for instructions). Exercises, perform foot and leg exercises to stretch and strengthen the leg
muscles & tendons. Increase calf flexibility by doing calf stretches several times per day. Protect the heel, your shoes might need a heel lift or arch support. Select a shoe with good arch
support and heel lift if possible. Take it one step at a time: gradually resume running and impact activities as symptoms allow.
Sever?s disease is self-recovering, meaning that it will go away on its own when the foot is used less or when the bone is through growing. The condition is not expected to create any long-term
disability, and expected to subside in 2-8 weeks. Some orthopedic surgeons will put the affected foot in a cast to immobilize it. However, while the disease does subside quickly, it can recur, for
example at the s It is more common in boys, although occurs in girls as well. The average age of symptom onset is 9-11.